Swim Lessons
In the traditional model, therapy is the extracurricular activity of the young neurodiverse. What are we really trying to teach?
It’s six P.M. on a Tuesday. Lindsey is driving her kids to swim lessons as they laugh and share an iPad in the backseat. She’s thinking about birthday parties and grocery lists, concerned about screen time and recitals. She laughs, thinking how busy she’ll be this summer. “What will I do when the school bus stops coming?”
It’s six P.M. on a Tuesday. Sara just picked up her son from school after another difficult day. He wouldn’t eat his lunch again. She’s frustrated but has seen progress —he can sit through dinner now and tie his shoes. Sara knows he’ll need help for a long time and doesn’t know what to do. “What will I do when the school bus stops coming?”
In the traditional model, “therapy” in some form is the extracurricular activity of the neurodiverse. There are soccer moms and karate dads, but then there are occupational therapy moms and speech therapy dads. There are people who need to learn how to swim in water, and people who need to learn how to swim in life. How are we doing that, though? Ostensibly, we are trying to provide instruction that affords children with autism the ability to behave and communicate in the same expected fashion as their typically developing peers. One of many problems with that statement is the fact that we’re doing so in the face of their vastly different lived experiences and perceptions.
Across cultures, humans follow a general developmental path with milestones like education, relationships, and aging. For many, those paths hit walls, temporarily or permanently. For the neurodiverse, those walls are often higher and take different forms. We invest our time trying to push them over those walls to rejoin the “typical” path. But rarely do we acknowledge there may be alternate routes that, while different, are no less valid and extraordinary.
As professionals, we have an obligation to think creatively, beyond our own clinical spaces. The current model of autism treatment is not adequately providing the comprehensive support most families want. We must move past billing conflicts between professions and invite more collaborative efforts. Our main goal should be facilitating growth and happiness through ethical, evidence-based methods — regardless of our professional titles. In my experience the only people who care about the letters after my name are the insurance companies.
This tunnel vision often leads to conflicts over who should handle what — behavior, sensory issues, social communication. Amid these debates, we lose sight of the core questions: What are we aiming to achieve, and why?
In my experience the only people who care about the letters after my name are the insurance companies.
We’ve siloed ourselves, each confined to our specialized knowledge. Meanwhile, insurance often falls short in covering comprehensive, interdisciplinary therapy for children with autism — or the support that families need. This shortfall has turned billing into a battleground among professionals. Instead of squabbling, we should explore alternative, cost-effective approaches that align with our ultimate goal: the well-being of the children we serve and the systems that support them. The current model doesn’t work, and we can only fix it together. When a square peg doesn’t fit a round hole, should we blame the peg, the hole, or the system that insists they must match?
I asked Lindsey what she wanted her kids to learn from swim lessons, and she said self-discipline; bodily awareness; teamwork, friendship, and social intelligence; perseverance in the face of hardship; flexibility in the face of failure. I asked Sara what she wanted her son to learn in therapy, and her answer was almost word for word the same.
I wonder whose program will be more successful, given that the swim instructor automatically has access to something I don’t: An instructional context that’s aligned with social and developmental expectations. If going to the pool with same-age peers is a more effective medium to teach social skills, flexibility, sensory acclimation, and more, then professional issues about scope of practice will become moot as every child with autism is pulled out of therapy and sent to swim lessons.
When you build your ivory tower that high, salesmen tend to set up tents at the base.
Autism professionals have lost public trust by allowing the snake oil salesmen to take the microphone, and no wonder when we put the evidence behind seven to eleven years of higher education and then a journal subscription. When you build your ivory tower that high, people tend to set up tents at the base.
IT’S 7 P.M. ON A TUESDAY and Lindsey is back at the gym picking up her children. I finish working with Sara’s son and walk back into the lobby (the last thing he says to me: “Are names still words, even if they’re weird?”). As she’s checking out, my office manager tells Sara she has seven visits left this year. “What do I do after that?” she asks. I pause and think of my friend Lindsey. “Have you considered swim lessons?”
Lucas “Luke” Steuber (MS CCC-SLP, MA Applied Linguistics) is an essayist, software engineer, clinician, and mental health advocate. lukesteuber.com
